Medication Administration

Nursing 1450

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 Administration of Medications

• Medication: substance administered for the diagnosis,

cure, treatment, or relief of a symptom or for prevention
of disease

• Drug: same as medication – but also refers to illicitly

obtained substance

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 Scientific Knowledge Base

• To safely and accurately administer medications you

need knowledge related to:
• Pharmacology
• Pharmacokinetics
• Life sciences
• Human anatomy
• Mathematics

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 Medication Legislation
and Standards

• Federal regulations
• State and local regulation of medication
• Health care institutions and medication laws
• Medication regulations and nursing practice

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 U.S. Drug Legislation

• Food, Drug, and Cosmetic Act (1938)

• Durham-Humphrey Amendment (1951)
• Kefauver-Harris Amendment (1962)
• Comprehensive Drug Abuse Prevention and Control Act
(1970)

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 Legal Aspects of Administering
Medications

• Nursing practice acts

• Responsibility for actions
• Question any order that appears unreasonable
• Refuse to give the medication until the order is clarified
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 Administration of Medications

• Prescription: The written direction for the preparation and

administration of a drug

• Generic name: name given before drug becomes officially

approved

• Official name: name which drug is listed in official publications

(United States Pharmacopeia)

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 Administration of Medications

• Chemical name: name that describes the constituents of the

drug

• Trade name: name given to drug by manufacturer (brand

name)

• Pharmacology: study of the effect of drugs on living organisms

• Pharmacy: Art of preparing, compounding, and dispensing

drugs

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 Pharmacological Concepts

• Drug names:
• Chemical, generic, trade
• Classification
• Medication forms:
• Solid, liquid, other oral forms, topical, parenteral, instillation
into body cavities

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 Pharmacokinetics

• The study of how medications:

• Enter the body
• Are absorbed and distributed into cells, tissues, or organs
• Alter physiological functions

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 Absorption

• The passage of medication molecules into the blood

from the site of administration
• Factors that influence absorption:
• Route of administration
• Ability to dissolve
• Blood flow to site of administration
• Body surface area
• Lipid solubility of medication

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 Drug Absorption

• Oral drug absorption video

http://www.youtube.com/watch?v=xiuWdJYyIKs
• IM absorption video
http://www.youtube.com/watch?v=6XiuWrgvhyY
• IV absorption video
http://www.youtube.com/watch?v=4G6Rem38aks

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 Distribution

• After absorption, distribution occurs within the body

to tissues, organs, and to specific sites of action.
• Distribution depends on:
• Circulation
• Membrane permeability
• Protein binding

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 Factors Affecting Medication
Action

• Developmental
• Gender
• Cultural, ethnic, and genetic
• Diet
• Environment
• Psychologic
• Illness and disease
• Time of administration
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 Drug Distribution &
Genetic Factors on Distribution

• Drug Distribution
http://www.youtube.com/watch?v=kLvYCOSnPDc

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 Excretion

• Medications are excreted through:

• Kidney
• Liver
• Bowel
• Lungs
• Exocrine glands

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 Excretion

• Pharmacology excretion
http://www.youtube.com/watch?v=4X8pAizadWI
• Drug Metabolism
http://www.youtube.com/watch?v=2uehdqZzKEM

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 Types of Medication Action
Therapeutic effect: Side effect:

Adverse effect: Toxic effect:

Idiosyncratic reaction: Allergic reaction:

Potentiating Effect Inhibiting Effect

Drug Concentration in Blood
Plasma After Single Dose

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 Medication Interactions

• Occur when one medication modifies the action of

another
• A synergistic effect occurs when the combined effect
of two medications is greater than the effect of the
medications given separately.

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 Medication Dose Responses
Serum half-life: Onset:
Time for serum medication Time it takes for a medication
concentration to be halved to produce a response

Peak: Trough:
Time at which a medication Minimum blood serum
reaches its highest effective concentration before next
concentration scheduled dose

Duration: Plateau:
Time medication takes to produce Blood serum concentration is
greatest result reached and maintained
 Therapeutic Actions of Drugs
Drug Type Description Examples
Palliative Relieves the symptoms of a disease Morphine Sulfate,
but does not affect the disease the ASA for pain
disease itself
Curative Cures a disease or condition PCN for infection
Supportive Supports body function until other Norepinephrine for
Tx’s or the body’s response can take ↓ B/P, ASA for ↑
over body temp
Substitutive Replaces body fluids or substances Thyroxin for
hypothyroidism,
insulin for DM
Chemotherapeutic Destroys malignant cell Busulfan for
leukemia
Restorative Returns the body to health Vitamins, mineral
supplements
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 Controlled Substances

• Kept under lock

• Special inventory forms
• Documentation requirements
• Counts of controlled
substances
• Procedures for discarding
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 Routes of Administration
Oral Parenteral
Sublingual, buccal ID, Sub-Q, IM, IV

Epidural, Intrathecal, Topical

Intraosseous,
Intraperitoneal,
Intrapleural, Intraarterial
Inhalation Intraocular
Oral Route

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 Parental Routes

• Intradermal (ID): Injection into the dermis just under the

epidermis
• Subcutaneous (sub-Q): injection into tissues just under
the epidermis
• Intramuscular (IM): Injection into a muscle
• Intravenous (IV): injection into a vein
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Intradermal Injections

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Administering Intradermal Injections

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Subcutaneous Injections

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Administering a Subcutaneous
Injection

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 Intramuscular Injections

• Ventrogluteal
• Vastus lateralis
• Dorsogluteal
• Deltoid
• Rectus femoris

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Ventrogluteal Site

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 Vastus Lateralis Site

infant
adult
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Deltoid Site

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Rectus Femoris Site

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 Topical Medication

• Trans-dermal Patches
• Ointment creams
• Eye drops
• Nose drops
• Suppository

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Administering Ophthalmic
Instillations

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Administering Otic Instillations

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Nasal Medications

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Administering Vaginal Instillations

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Inserting Rectal Suppository

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Respiratory Inhalation

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Feeding tubes

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Nasal gastric-tube

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Figure 47-13 (continued) Nasoenteric feeding tubes. A, 12 Fr 36 in.; B, 8 Fr opaque, 45 in., stylet, weighted tip. Note that both have a Y-port connector to permit irrigation
and medication administration without disconnecting feeding device. (Courtesy of Ross Products Division of Abbott Laboratories, Columbus, Ohio.)

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Figure 47-15 Percutaneous endoscopic jejunostomy (PEJ) tube.

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Figure 47-14 Percutaneous endoscopic gastrostomy (PEG) tube.

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 Nurse’s Role in Administration
Medications

The six rights of drug administration:

1. Right Medication
2. Right Dose
3. Right Client
4. Right Route
5. Right Time
6. Right Documentation
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 Nurse’s Role in Administration
Medications

• The patient’s six rights to medication administration

http://www.youtube.com/watch?v=kdB0PmsX2ng

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 Maintaining Client’s rights in
relation to medication

• Safely Administered
• Six rights
• Right to refuse

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 Nursing Knowledge Base

• Safe administration is imperative.

• Nursing process provides a framework for medication
administration.
• Clinical calculations must be handled without error.
• Conversions in and between systems
• Dose calculations
• Pediatric and elderly calculations

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Systems of Medication Measurement

• Requires the ability to compute medication doses

accurately and correctly
• Metric system
• Household system
• Solution

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 Prescriber’s Role

• Prescriber can be physician, nurse practitioner, or

physician’s assistant.
• Prescribers must document the diagnosis, condition,
or need for each medication.
• Orders can be written, verbal, or by telephone.

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 Types of Orders in Acute Care
Agencies
Standing or Routine: PRN:
Administered until the dosage Given when the client requires
is changed or another it
medication is prescribed
Single one-time: STAT:
Given one time only for a Given immediately in an
specific reason emergency

Now: Prescriptions:
When a medication is needed Medication to be taken outside
right away, but not STAT of the hospital
 Medication Administration

• Pharmacist’s role
• Distribution system
• Nurse’s role
• Medication error

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 Mediation Errors

• Inaccurate prescribing
• Administering the wrong medication
• Wrong route
• Wrong time
• Extra doses
• Failing to give medication
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 After a Medication Error

• Assess the client condition

• Report to the appropriate person
• Incident report within 24 hours
• ID number
• Time
• Location
• Accurate, factual account of what incident
• Who was involved

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Drug Misuse
• Improper use of medications
• Drug abuse
• Drug dependence
• Physiologic dependence
• Psychologic dependence
• Drug habituation
• Illicit drugs

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 Nursing Process and Medication
Administration

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

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Medication effect in the Older Adult

• Drug-receptor interaction
• Circulation
• Metabolism
• Excretion
• Absorption
• Distribution
• Polypharmacy
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 Medication Administration

• Assessment
• History
• Allergies
• Diet history
• Client current condition
• Medication history
• Client understanding
• Learning needs

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 Medication Reconciliation

• Compares medication previous took prior to admission

• Verify current list of medication
• Clarify to accuracy
• Reconcile compare new list with old
• Transmit and update list with client
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 Medication Administration

• Nursing Diagnosis
• Anxiety
• Ineffective Health Maintenance
• Health seeking behaviors
• Deficient knowledge
• Noncompliance
• Impaired swallowing
• Effective/ineffective therapeutic regimen management

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 Medication Administration

• Goals
• Set priorities
• When giving medication and planning care
• Collaborative Care
• Prescriber
• Pharmacist
• Family
• Community

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 Medication Administration

• Implementation
• Health promotion
• Teaching
• Restorative care

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 Medication Administration

• Evaluation
• Client response to medication

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 Case Study

• Mr. Jones 48 years old has been admitted to the hospital with a
diagnosis of hyperglycemia. On admission Mr. Jones blood
sugar was 498. Mr. Jones is a laid off auto worker with no
insurance. Mr. Jones last saw a doctor 3 years ago who
diagnosed him with diabetes mellitus, and him treated with
subcutaneous humulin insulin. Mr. Jones live with wife who
works 12 hours a day five days a week since Mr. Jones has been
laid off.

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 Case Study

• The nurses in the hospital attempted to complete his

teaching, but were unsuccessful. Now he is home and is
to be started on a diet regimen and insulin. He is reluctant
to inject himself with insulin and is having trouble reading
the insulin syringe. The community health nurse has been
called into the home to assist in the transition process.

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Complementary and Alternative
Therapies

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• Allopathic Medicine

• Complementary Therapy

• Alternative Therapy
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 Complementary or Alternative Therapies
in Health Care
• Complementary
• These therapies are used in
addition to conventional • Alternative
treatment:
• These therapies replace
• Therapeutic touch
allopathic medical care:
• Imagery
• Chiropractic
• Relaxation • Feldenkrais
• Exercise • Chinese medicine
• Reflexology • Ayurvedic medicine
• Art, music, dance • CAM
• Biofeedback

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 Training-Specific Therapies
Biofeedback Therapeutic touch

Chiropractic therapy Traditional Chinese

medicine

Acupuncture Herbal therapies

 Herbal Therapies

• Do not under go the same research as pharmaceuticals

• Most do not receive approval for the use as drugs and are
regulated by the FDA
• Dietary supplement Health and Education Act of 1994
• Chinese
• Plants, animals, or minerals
• Western
• Plants

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 Herbal Therapy
Common Name & Use Effects Drug interaction
Chamomile/ Acceleration of wound Lasix loop diuretics,
Inflammatory of GI or healing / anti- ETOH Barbiturates,
upper resp. inflammatory benzo’s, narcotics
Echinacea/ Upper resp. Stimulant on immune Medication that weakens
infection system immune system
Gingko biloba/ Alzheimer Memory improvement Coumadin, aspirin,
dementia NSAID’s
Ginseng/ age related Increased physical Blood thinners,
diseases endurance immunosuppressive
Ephedra/ CNS stimulant, Unsafe in people with
bronchodilator, cardiac HTN, DM, Thyroid
stimulant problems
 Nursing-Accessible Therapies

• Relaxation therapy
• Progressive relaxation
• Passive relaxation
• Meditation and breathing

• Imagery
• Creative visualization

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 Nursing Role in Complementary and
Alternative Therapies

• Multiple practitioner approach

• Holistic in nature
• Follow Nurse Practice Act Scope of Practice
• Work closely with client

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